波前像差引导联合虹膜定位技术的准分子激光上皮瓣下角膜磨镶术后视觉质量

摘要

目的 分析波前像差引导联合虹膜定位技术的准分子激光上皮瓣下角膜磨镶术(Epi-LASIK)的临床疗效.方法 回顾性研究.行波前像差引导联合虹膜定位技术的Epi-LASIK手术的患者37例(73眼),按等效球镜度(SE)不同分为低中度近视组(SE＜-6.00 D,30眼)和高度近视组(SE≥-6.00 D,43眼).所有患者手术前后均行UCVA 、BCVA、屈光度、裂隙灯显微镜、眼压、角膜地形[图、波前像差以及对比敏感度(CS)等检查,术后1周、1个月、3个月、6个月进行定期随访.应用t检验、方差分析和卡方检验对患者手术前后的各项观测指标进行对比研究.结果 ①术后UCVA(5分视力):术后低中度近视患者UCVA较高度近视患者好,恢复快.术后6个月时,低中度近视组UCVA平均为5.05±0.1 1;高度近视组平均为5.01±0.11,2组间差异无统计学意义(t=1.69,P＞0.05).②屈光度:所有患者术后6个月内屈光度稳定,术后6个月时低中度近视组屈光度为(+0.16±0.43)D,高度近视组为(-0.21±0.64)D.③角膜后表面高度变化:术后1个月、3个月、6个月间比较,角膜后表面高度稳定,未见明显变化(F=0.57,P＞0.05),与术前比较明显降低(F=20.87,P＜0.05);低中度近视组和高度近视组间术后各时间点角膜后表面高度差异无统计学意义(F=1.22,P＞0.05).④高阶像差:所有患者中除了三叶草比术前稍降低外,总高阶像差、垂直彗差、水平彗差以及球差均方根值均较术前增加,高度近视组各阶像差值均高于低中度近视组.⑤CS:绝大多数患者术后CS和眩光敏感度(GS)逐渐升高,在术后3个月时达到高峰.无论是低中度近视还是高度近视患者手术后各空间频率的CS及GS均无下降;低中度近视患者术后各空间频率的CS及GS普遍高于高度近视患者⑥所有患者术后均未发生严重并发症结论 波前像差引导联合虹膜定位技术的Epi-LASIK手术具有良好的精确性、可预测性和稳定性,并且能为患者带来较好的视觉质量,低中度近视患者手术效果更好.%Objective To comprehensively analyze the clinical efficacy of wavefront guided epipolis LASIK (Epi-LASIK) combined with iris recognition.Methods In a prospective study of wavefront guided Epi-LASIK combined with iris recognition,37 patients (73 eyes) with myopia underwent treatment.The patients were divided into a low-to-moderate myopia group (SE＜-6.00 D,30 eyes) and a high myopia group (SE≥-6.00 D,43 eyes).All patients were required to undergo preoperative and postoperative examinations that included UCVA,BCVA,refractive status,intraoeular pressure,anterior segment slit lamp examinations,corneal topographic tests,WaveScan aberrometer tests,contrast sensitivity (CS) tests,etc.Patients were evaluated at 1 day,1 week,and 1 month,3 months and 6 months postoperatively.A t test,ANOVA and chi-square test were used to compare results.Results ①Postoperative UCVA:Low-to-moderate myopia patients improved and recovered UCVA faster and better than high myopia patients.At 6 months postoperatively,UCVA in low-to-moderate myopia patients was 5.05±0.11 and was 5.01±0.11 in high myopia patients.There was no significant difference between the groups (t=1.69,P＞0.05).②Refraction accuracy:refraction in all patients stabilized within 6 months postoperatively.At 6 months postoperatively,refraction in low-to-moderate myopia patients was +0.16±0.43 D and was-0.21±0.64 D in high myopia patients.③The height of the corneal posterior surface:there was a noticeable drop in height after refractive surgery and the surface remained stable postoperatively in all patients.There was no significant difference between the 2 groups.④Higher order aberrations (HOA):there was an increase in total HOA,coma and spherical aberration in all patients postoperatively.Only trefoil conversely decreased.High myopia patients developed more aberrations than low-to-moderate myopia patients.⑤CS:the vast majority of patients had a gradual increase in CS and glare sensitivity (GS) postoperatively,reaching a peak at 3 months.Preoperative comparisons showed that CS and GS did not significantly drop in any patients postoperatively.Low-to-moderate myopia patients had better CS and GS for each spatial frequency than high myopia patients.⑥No patient had serious postoperative complications.Conclusion Wavefront-guided Epi-LASIK combined with iris recognition is more accurate,predictable and stable and results in better visual quality.Clinical efficacy is better for low-to-moderate myopia patients than for high myopia patients.